Stress & Sleep Quiz

Step 1 of 4

DIRECTIONS
Please read each statement and choose the number 0, 1, 2, or 3 that best describes your feelings or reactions throughout the course of the day. Some questions may appear redundant between sections. There’s a reason for each question. Don’t spend much time on any one question.
SECTION A
When under stress for 2 weeks or longer...
I get wound up when I get tired and have trouble calming down
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I feel driven, appear energetic but feel “burned out” and exhausted
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I feel restless, agitated, anxious, and uneasy
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I feel easily overwhelmed by emotion
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I am constipated
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I sleep less than seven hours a night
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I forget to eat and feel little hunger
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I find myself worrying about things big and small
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I feel aggressive, unyielding, or inﬂexible when pressed for time
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I stay awake replaying the events of the day or planning for tomorrow
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
This field is hidden when viewing the form
Section A Total*
NOTE: This field will populate automatically based on your answers. You do not need to fill out anything.

SECTION B
When under stress for 2 weeks or longer...
I have muscle and joint pains
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I have muscle weakness
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I crave salt or salty things
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I have multiple points on my body that when touched are tender or painful
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I have dark circles under my eyes
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I feel a sudden sense of anxiety when I get hungry
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I use medications to manage pain
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I get dizzy when rising or standing up from a kneeling or sitting position
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I have diarrhea or bouts of nausea with or without vomiting for no apparent reason
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I have headaches
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
This field is hidden when viewing the form
Section B Total*

SECTION C
When under stress for 2 weeks or longer...
I have trouble organizing my thoughts
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I get easily distracted and lose focus
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I have difficulty making decisions and mistrust my judgment
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I lack the motivation and energy to stay on task and pay attention
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I feel unsettled, restless, and anxious
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I experience lingering mild fatigue after exertion or physical activity
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I feel depressed and apathetic
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I have little or no interest in sex
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I have no energy and feel physically weak
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
I feel dragged down by multiple symptoms, such as poor digestion and body aches
0 = Never True | 1 = Seldom True (1 day/week) | 2 = Sometimes True (2 or 3 days/week) | 3 = Often True (4 or more days/week)
This field is hidden when viewing the form
Section C Total

SECTION D
When under stress for 2 weeks or longer...
I get a second wind at night (such as finishing up a project or chore, starting a new project, or binging shows etc.)
0 = Never True | 1 = Seldom True (1 night/week) | 2 = Sometimes True (2 or 3 nights/week) | 3 = Often True (4 or more nights/week)
I have trouble falling asleep because I keep replaying the day or thinking about the next day
0 = Never True | 1 = Seldom True (1 night/week) | 2 = Sometimes True (2 or 3 nights/week) | 3 = Often True (4 or more nights/week)
I have trouble staying asleep because I'll wake up (or "shadow up"), maybe go to the bathroom, and then not be able to fall back asleep within 5 minutes
0 = Never True | 1 = Seldom True (1 night/week) | 2 = Sometimes True (2 or 3 nights/week) | 3 = Often True (4 or more nights/week)
I have trouble both falling and staying asleep. I don't replay the day but still can not fall asleep even with meditation or listening to an audiobook. Once I do manage to fall asleep, I am a light sleeper and wake frequently.
0 = Never True | 1 = Seldom True (1 night/week) | 2 = Sometimes True (2 or 3 nights/week) | 3 = Often True (4 or more nights/week)
This field is hidden when viewing the form
Section D Total
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Stress & Sleep Quiz

Step 1 of 4

DIRECTIONS

SECTION A

SECTION B

SECTION C

SECTION D

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